{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:59:07Z","timestamp":1785301147175,"version":"3.55.0"},"reference-count":13,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":208,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Critical Care"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Streptococcal toxic shock syndrome (STSS) is a life\u2010threatening condition with increasing incidence and high mortality worldwide. It is characterised by hypotension and multiorgan failure, resultant of invasive group A Streptococcus (GAS) infections. Intravenous immunoglobulin (IVIG) has been proposed as an adjunctive therapy that reduces mortality in patients with STSS, and is thought to exert its effects by neutralising streptococcal superantigens and exotoxins to modulate the host immune response. Currently, there is a paucity of knowledge about the efficacy of repeated dosing if patients remain unstable after the first dose of IVIG. In this report, we describe the case of a woman in her 60s with STSS and meningoencephalitis, who demonstrated an improvement in haemodynamic status after the first dose of IVIG, but subsequently had rebound of hypotension and high vasopressor requirements, which resolved after a second dose of IVIG. This case highlights the potential need for repeated dosing of IVIG in STSS, in situations where an initial improvement in haemodynamic status is followed by deterioration.<\/jats:p>","DOI":"10.1155\/crcc\/9649482","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:04:21Z","timestamp":1785297861000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Use of Double Dose Intravenous Immunoglobulin Therapy in the Treatment of Streptococcal Toxic Shock Syndrome"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6479-2916","authenticated-orcid":false,"given":"Yuning","family":"Xue","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2901-496X","authenticated-orcid":false,"given":"Alex","family":"Yartsev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"e_1_2_9_1_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1993.03500030088038"},{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid2809.212129"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2007.tb01054.x"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/1753-6405.13290"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/imj.14807"},{"key":"e_1_2_9_6_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268815002010"},{"key":"e_1_2_9_7_2","doi-asserted-by":"publisher","DOI":"10.1086\/515199"},{"key":"e_1_2_9_8_2","doi-asserted-by":"publisher","DOI":"10.1086\/514588"},{"key":"e_1_2_9_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.66.5.2279-2283.1998"},{"key":"e_1_2_9_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu304"},{"key":"e_1_2_9_11_2","unstructured":"National Blood Authority Criteria for the Clinical Use of Immunoglobulin in Australia 2018 https:\/\/www.blood.gov.au\/supply-system\/governance-immunoglobulin-products\/criteria-immunoglobulin-products."},{"key":"e_1_2_9_12_2","unstructured":"Therapeutic Guidelines Limited Antimicrobial Dosage Modification in Kidney Impairment 2025 https:\/\/www.tg.org.au."},{"key":"e_1_2_9_13_2","unstructured":"\u201cBenzylpenicillin\u201d In Renal Drug Database 2023 https:\/\/www.renaldrugdatabase.com.acs.hcn.com.au\/s\/article\/BENZYLPENICILLIN."}],"container-title":["Case Reports in Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crcc\/9649482","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/crcc\/9649482","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crcc\/9649482","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:04:22Z","timestamp":1785297862000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/crcc\/9649482"}},"subtitle":[],"editor":[{"given":"Lipi","family":"Buch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":13,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/crcc\/9649482"],"URL":"https:\/\/doi.org\/10.1155\/crcc\/9649482","archive":["Portico"],"relation":{},"ISSN":["2090-6420","2090-6439"],"issn-type":[{"value":"2090-6420","type":"print"},{"value":"2090-6439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-09-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"9649482"}}